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On Cue: Striatal Ups and Downs in Addictions

  • Marco Leyton
    Correspondence
    Corresponding author
    Affiliations
    Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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  • Paul Vezina
    Affiliations
    Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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  • Author Footnotes
    1 In a large study of heavy drinkers (n = 326), the greater the severity of alcohol use problems, the greater the alcohol cue-induced striatal activation (43).
    2 The lower responses seen in subjects with a long history of severe substance abuse have been proposed to reflect multiple factors, including toxic drug effects and preexisting vulnerability traits. Whether the presence vs. absence of drug-related cues contributes to the blunted responses in these individuals will require further investigation.
    3 In healthy subjects (individuals whose appetitive urges are not pathologically tied to a particular set of stimuli), tasks such as the Balloon Analog Risk Task and the Monetary Incentive Delay are thought to be good tests of representative responses to rewards. In gamblers or others with addictions or impulse control disorders, though, the cues in these tasks might become less salient and less able to activate the striatum. This progressive narrowing of stimuli that can potently activate the striatum might account for a wide range of motivational perturbations (4142).
      Two recent papers report that problem gamblers exhibit altered striatal responses to cues that predict monetary reward, as compared with healthy controls. Significantly, however, in one study the activation was increased (
      • van Holst R.J.
      • Veltman D.J.
      • Büchel C.
      • van den Brink W.
      • Goudriaan A.E.
      Distorted expectancy coding in problem gambling: is the addictive in the anticipation?.
      ), whereas in the other it was decreased (
      • Balodis I.M.
      • Kober H.
      • Worhunsky P.D.
      • Stevens M.C.
      • Pearlson G.D.
      • Potenza M.N.
      Diminished frontostriatal activity during processing of monetary rewards and losses in pathological gambling.
      ). We propose that this discrepancy could result from the fact that different types of cues were used. In the study by van Holst et al. (
      • van Holst R.J.
      • Veltman D.J.
      • Büchel C.
      • van den Brink W.
      • Goudriaan A.E.
      Distorted expectancy coding in problem gambling: is the addictive in the anticipation?.
      ), the cues were images of familiar playing cards. In comparison, Balodis et al. (
      • Balodis I.M.
      • Kober H.
      • Worhunsky P.D.
      • Stevens M.C.
      • Pearlson G.D.
      • Potenza M.N.
      Diminished frontostriatal activity during processing of monetary rewards and losses in pathological gambling.
      ) used cues that consisted of text. One interpretation of these divergent results could be that in individuals with reward-seeking disturbances incentive processes become pathologically tied to a narrow set of stimuli. When the relevant cues are present, striatal activation is greater; when the cues are absent, it is blunted. Both changes are likely to be important.
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      Linked Article

      • Attending to Striatal Ups and Downs in Addictions
        Biological PsychiatryVol. 72Issue 10
        • Preview
          Altered striatal responses during monetary reward anticipation have recently been reported in pathological gambling (PG). Whereas van Holst et al. (1) reported an increased response, Balodis et al. (2) found a diminished response. Leyton and Vezina proposed that these divergent results may relate to cue specificity; in addicted populations addiction-related cues increase striatal activity, whereas in the absence of such cues, diminished striatal activity is observed. The authors suggested that the playing cards presented by van Holst et al.
        • Full-Text
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      • Right on Cue? Striatal Reactivity in Problem Gamblers
        Biological PsychiatryVol. 72Issue 10
        • Preview
          The commentary by Leyton and Vezina (1) addresses how to interpret the seemingly contradictory findings of two published papers in Biological Psychiatry on reward processing in problem gambling (PrG) (2,3). Leyton and Vezina propose that these contrasting findings could be explained by differences in specific cues used. They argue that problem gamblers show enhanced striatal activation when confronted with disorder-specific cues and attenuated responses to disorder-irrelevant appetitive stimuli.
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